Professional Documents
Culture Documents
August 2007
Review Date August 2008
1
Contents Page Number
Introduction 3
The scope of this guidance 3
Structure and use of the guidance 4
Aim of this guidance document 5
Process for the development of this guidance 6
Format of the quality educational framework 6
Section A The Quality Educational Framework
Topic 1. Preparation the injection: responsibilities of staff (e.g. nurses, doctors and pharmacists) 8
Topic 2. Hazards involved in the preparation of injections 14
Topic 3. Calculations and checking procedures during the preparation of injections 18
Topic 4. Drug incompatibilities 20
Topic 5. The stability of prepared injections 22
Topic 6. Displacement values of injections 23
Topic 7. Aseptic technique for the preparation of injections 24
Topic 8. Standard preparation methods for preparing injections 26
Topic 9. Checking procedures prior to, and during administration of injections 28
Topic 10. Documentation for the preparation and administration of injections 30
Topic 11. Labelling requirements for injections 32
Topic 12. Disposal of waste, including medicines, containers and sharps 33
Topic 13. Product monographs 35
Topic 14. Awareness of the Control of Substances Hazardous to Health (COSHH) and other 35
safety considerations
Section B Examples of practice 39
Section C Examples of minimum information for inclusion in educational programmes 42
Acknowledgements 48
Appendices
Appendix I References 49
Appendix II Glossary of terms 50
Appendix III Membership of the steering group and reference groups 53
Appendix IV Respondents to the consultation 55
2
Introduction
Improving the patient experience is at the heart of the National Health Service. Standards and quality of care must remain consistently high, regardless of
who performs a clinical intervention and where it is performed. The preparation of injections in the near-patient area, defined as the area where the patient is
examined, treated and cared for in clinical settings and patient homes, should be carried out by suitably educated healthcare staff in a suitable environment,
using safe procedures. Healthcare professionals need to be educated in the preparation of injections in near-patient areas as this is where the majority of
injections are prepared prior to administration. This education should take the form of a dedicated competency based training programme. The training should
be available for all members of the healthcare team who are required to prepare and administer injections in near - patient areas, for example nurses, doctors
and pharmacists. Following attendance at an initial educational course, the competence of practitioners should be reassessed on a regular basis (e.g. every 3
years).
This guidance was developed using current course programmes, course workbooks and other documentation submitted by practitioners who are currently
involved in the education of practitioners within secondary care in NHS Scotland.
Additional education will be required for high risk injections, (e.g. chemotherapy, intrathecal and epidural injections) and for high risk patient groups, (e.g.
paediatric patients).
3
Structure and use of the guidance document
Section A shares the educational framework, in 14 distinct sections. Each section details the various topics that need to be included in a local
educational programme to ensure compliance with the CRAG publication ‘Good Practice Statement for the Preparation of Injections
2
In Near-Patient Areas, Including Clinical and Home Environments’. Preceding, each topic are key references with web links which
enable educators and practitioners to access the a wide variety of underpinning knowledge that support of the various competencies.
Section B shares information on current practice throughout Scotland. This information was submitted during the scoping exercise.
Section C details the minimum underpinning knowledge that should be provided within a local educational programme.
The purpose of this guidance is to provide a foundation for the further development of good practice and to facilitate consistency in the approach to the
teaching about the preparation and administration of injections in near-patient areas. It is designed to complement, support and strengthen a range of quality
assurance measures already in place within NHS Scotland. By following this guidance practice educators will facilitate the ‘transfer of skills’ for the
preparation of injections in near - patient areas between organisations and Health Boards throughout Scotland.
3
The guidance document is one of a number of publications to support the education and training of the healthcare team in Scotland. A number of staff from
clinical practice and education were involved in development of this guidance and their contribution is acknowledged.
The development of this guidance has been facilitated by NHS Education for Scotland (NES) in liaison with NHS Quality Improvement Scotland and key
partners within the service.
References
Please see Appendix 1 for members of the reference group for development of this document.
4
Aim of the guidance
As stated by SEHD within Good Practice Statement for the Preparation of Injections in Near - Patient Areas, including Clinical and Home Environments, any
training provided should consist of as a minimum, information relating to:
At all stages of the preparation and administration process injections must be clearly identifiable. This should be achieved through clear, accurate labelling of
the product or by a locally agreed documented system.
NHS Scotland staff who have responsibility for developing and delivering education and training in the preparation of injections in near-patient areas, are
encouraged to use this guidance to:
○ map existing educational programmes to the recommendations as detailed in HDL (2002) 91 Good Practice Statement for the Preparation of Injections
2,3,4
in Near - Patient Areas, Including Clinical and Home Environments
○ design, develop and deliver new improved educational programmes for the training of healthcare practitioners within their local area
○ be informed of aspects of practice as identified from the scoping exercise undertaken as part of this project
5
Process for development of the guidance
o reviewing the content of local training programmes, local educational frameworks and recognised reference sources provided as part of the
scoping exercise for this project
o consulting with multi disciplinary steering and reference groups specifically convened for this project
The quality educational framework consists of a variety of quality standards which have been designed to articulate the professional standards required as
1
detailed within The Health Department Letter (HDL (2002) 91 and the document ‘Good Practice Statement for The Preparation of Injections in Near-Patient
2
Areas, including Clinical and Home Environments .
Section A: The competency framework details the various competencies that practitioners should be able to achieve after attending a local training session.
The competencies provide the educator with topics that are required to be included should they wish the local training programme to reflect the
various requirements as detailed in the CRAG document. Key reference sources are detailed and web links provided where possible.
Some references require a subscription to a specified nursing journal and others may be located through the e – library.
Under each topic the relevant elements for inclusion in a local training programme are detailed. In relation to each element, Suggestions for demonstration of
achievement of the various elements of training are proposed. Achievement may be by achieved by e.g. attending a training session and/or by self directed
reading.
Section B: Details examples of practice that were identified from the ‘scoping exercise’ that was undertaken as part of this project.
Section C: Details suggested minimum information that should be included as part of the underpinning knowledge within the delivery of the local educational
programmes.
6
Skills for health
http://www.skillsforhealth.org.uk/page/competences/completed-competencies-projects/list
Where possible the competencies have been mapped to the various skills for health.
7
The Quality Educational Framework
Section A
Topic 1
General Underpinning Knowledge Access the e - library website
http://www.elib.scot.nhs.uk/portal/elib/pages/index.aspx?referer=AAS&un=nousername
Topic 1: Preparation of the Injection- responsibilities of staff General Underpinning Knowledge/Directed Reading
Guidelines for Records and Record Keeping Guidance 01 05 Published 2005 http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=516
A-Z Advice Sheet The Administration of Medicines 2004 Last Updated July 2006 http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1801
8
Nursing Standard 2005
Ingram P, Lavery I (2005) Peripheral intravenous therapy: key risks and implications www.nursing-standard.co.uk/archives/ns/vol1946/pdfs/v19n46p5564.pdf
for practice. Nursing Standard, 19 (46) 55-64.
Nursing Standard
Hyde, L. (2002) Legal and professional aspects of intravenous therapy.
Nursing Standard , 16 (26): 39-42.
www.nursing-standard.co.uk (Archives) Please note that you need to be registered
with Nursing Standard to access this article
Competency 1.4
Medicines, Ethics and Practice: A Guide for Pharmacists Medicines for Human Use http://www.rpsgb.org.uk/pdfs/MEP30s1-2a.pdf
9
Competency 1.10 Local Policies and Procedures for obtaining consent from a patient
Supporting Nurses and Midwives Through Life Long Learning Published 04/02
http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=519
Competency 1.13
The Department of Health ( 2004 )The NHS Knowledge and Skills Framework and
the Development Review Process, London:DH
www.paymodernisation.scot.nhs.uk/afc/ksf/docs/ksf%20handbook.pdf
10
Section A
Competency Framework
Topic 1: Preparation of the Injection- Responsibilities of Staff (e.g. nurses, doctors and pharmacists)
Learning Outcomes Learning Method How Competence is Assessed
1.1
Be able to discuss the legal, ethical and Directed reading + Completion of individual professional CPD record
professional issues that need to be Local course for the preparation of Assessment by experienced practitioner during period of supervised practice
considered when a practitioner prepares injections
or administers an injection
1.2
Be able to describe the role and Directed reading + Completion of individual professional CPD record
responsibility of a practitioner when Local course for the preparation of Assessment by experienced practitioner during period of supervised practice
preparing /administering an injection injections
1.3
Be able to describe the procedures that Directed reading + Assessment by experienced practitioner during period of supervised practice
the practitioner must follow to ensure Local course for the preparation of
that administration of a medicine by injections
injection is in the best interest of the
patient and is the most appropriate route
for the drug and the dose prescribed
1.4
Be able to describe the reasons for the Directed reading + Written report or testimonial
development of standard procedures for Local course for the preparation of +
the preparation of injections and the injections Appropriate completion of documentation during period of supervised practice
reasons for using standard,
documentation when prescribing,
preparing or administering injections
11
1.5
Be able to describe organisational Directed reading + Appropriate completion of related local documentation
personnel reporting structures and the Local course for the preparation of
documentation required when a injections
practitioner prepares/ administers an
injection
1.6
Be able to describe the reasons for Local course for the preparation of Assessment by experienced practitioner during period of supervised practice
‘regular ‘ (e.g. annual), audit of the injections
practice of preparing injections within the
vicinity of the patient and be able to
describe the documentation required in
order to undertake such an audit
1.7
Be able to describe the rational for the Directed reading + Testimonial following assessment during supervised practice
prescribing of at least 3 different types of Local course for the preparation of
injections by a practitioner and be able to injections
justify that the prescription is in the best
interest of the patient
1.8
Be able to describe the duty of care of Directed reading + Written report or testimonial
the practitioner when they prepare or Local course for the preparation of
administer an injection injections
1.9
Be able to describe the local procedure Directed reading + Testimonial following observation during period of supervised practice
to be followed to obtain appropriate Local course for the preparation of
consent from a patient injections
1.10
Be able to describe the practitioner’s role Local course for the preparation of Written report or testimonial after period of supervised practice
in the monitoring of the patient prior to, injections
during and after administration of an
injection
12
1.11
Be able to describe the local procedure Directed reading + Written report or testimonial after period of supervised practice
for the reporting of adverse events or Attendance at local training sessions
medication incidents and be able to
identify the documentation required for
the reporting of such an event/incident
1.12
Be able to demonstrate continued Directed reading + Annual PDP meeting
competence Attendance at the local course for the
preparation of injections Assessment every 3 years
13
Section A
General Underpinning Knowledge
Topic 2
Topic 2: Hazards involved in the Preparation and Administration of General Underpinning Knowledge/Directed Reading
Injections
Nursing Standard
Gould D. (2000) Hand decontamination, Nursing Standard, 15 (6), 45-50. www.nursing-standard.co.uk
Professional Nurse
Keirnan, M. ( 2003) Reducing the risks of device-related infection caused by http://www.professionalnurse.net/
staphylococci. Nursing Standard, 18 (8), 441-444.
CARDS
Centre for Adverse Reactions to Drugs (Scotland) Yellow Card Centre Scotland
http://www.yccscotland.scot.nhs.uk/
14
Underpinning Knowledge for Specific Competencies
Competency 2.1
Local policies/guidance for the :
Competency 2.4 Local policies and procedures relating to the management of injection related
hazards e.g.:
Blood spillage
Needle stick injuries
Infection control
Competency 2.5 Local policies and procedures relating to the management of hazards
15
Section A
Competency Framework
Topic 2: Hazards Involved in the Preparation and Administration of Injections
2.1
Be able to assess, plan, implement, Directed reading + Completion of individual professional CPD record + Written Report or Testimonial
evaluate and prioritise the most suitable Local course for the preparation of during period of supervised practice
route of administration of a medicine injections
depending on individual patient
requirements/clinical condition
2.2
Be able to describe the different routes Directed reading + Completion of individual professional CPD record + Written Report or Testimonial
of administration (inc. a variety of Local course for the preparation of during period of supervised practice
different formulations) injections
Be able to describe at least two
advantages and two disadvantages of
administering medicines by each of the
different routes
2.3
Be able to describe the referral Local course for the preparation of Completion of risk assessment during period of supervised practice
mechanism for ‘high risk’ medicines that injections + Supervised practice
are not suitable to be prepared within
the near-patient area
2.4
Be able to identify and discuss the Directed reading + Testimonial following assessment during period of supervised practice
management of , a variety of hazards Local course for the preparation of
that may affect the practitioner /others injections
during the preparation of an injection.
16
2.5
Be able to identify a variety of potential Directed reading + Testimonial following assessment during period of supervised practice +
hazards that may affect the patient Local course for the preparation of Completion of risk assessment during period of supervised practice
receiving the medication injections
2.6
Be able to describe potential hazards Directed reading Testimonial following assessment during period of supervised practice
that may occur during the administration
of an injection. Be able to discuss the
management of such hazards.
2.7
Be able to identify the correct handling and Local course for the preparation of Testimonial following assessment during period of supervised practice
storage of medicines and be able to injections
describe at least 3 hazards and their
management, that may occur when
medicines are stored out with the clinical
environment
2.8
Be able to discuss the local and national Local course for the preparation of Testimonial following assessment during period of supervised practice
procedure for the reporting of a suspected injections
adverse drug reaction
17
Section A
General Underpinning Knowledge
Topic 3
Topic 3: Calculations and Checking Procedures During the Preparation General Underpinning Knowledge/Directed Reading
of Injections
Lapham R., Agar H. (2003) Drug Calculations for Nurses: a step- by- step
approach, London: Arnold.
Competency 3.2 Local policies and procedures for the administration of medicines by infusion
pump.
18
Section A
Competency Framework
Topic 3: Calculations and Checking Procedures During Preparation of Injections
3.1
Be able to calculate doses correctly Directed reading + Individual assessment by completion of calculations prior to supervised practice (e.g.
assessment to agreed local standard)
Completion of calculations through +
examples and assessment Assessment during period of supervised practice
+ +
1 : 1 support /group support Completion of individual professional CPD record
(if required)
3.2
Be able to describe the principles of Directed reading + Testimonial following assessment during period of supervised practice
safe administration of medicines via
an infusion pump and be able to Local course for the preparation of
demonstrate the safe administration of injections +
a drug via an infusion pump
Period of supervised practice
3.3
Demonstrate a systematic approach Directed reading + Testimonial following assessment during period of supervised practice
to the preparation of injections and be Local course for the preparation of
able to describe the various checks injections
that are required to be undertaken to
ensure that the product (injection) is
prepared according to standard
procedures
19
Section A
General Underpinning Knowledge
Topic 4
Pickstone M., (1999) A pocket book for safer IV therapy (Drugs, Giving sets
and Infusion pumps). Scitech Educational, Margate.
20
Section A
Competency Framework
Topic 4: Drug Incompatibilities
4.1
Be able to :
i) recognise and discuss potential drug Directed reading + Testimonial following assessment during period of supervised practice
interactions and incompatibilities Local course for the preparation of +
injections + Consider practical Written report
ii) identify reference sources that detail: demonstration/video
drug-drug incompatibilities, drug fluid
incompatibilities and fluids to which
drugs should not be added when
they are being administered
4.2
Be able to discuss the various factors that Local course for the preparation of Testimonial following assessment during period of supervised practice
may dictate the volume of the diluent injections
used when preparing an injection
21
Section A
General Underpinning Knowledge
Topic 5
Section A
Competency Framework
Topic 5: The Stability of Prepared Injections
5.1
Be able to describe the factors that Directed reading + Testimonial following assessment during period of supervised practice
influence the stability of an injection when Local course for the preparation of +
prepared and administered in a near – injections Completion of individual professional CPD record
patient area
22
Section A
General Underpinning Knowledge
Topic 6
Competency 6.1 Lapham R., Agar H. (2003) Drug Calculations for Nurses: a step- by- step
approach. London, Arnold.
Section A
Competency Framework
Topic 6: Displacement Values
Learning Outcomes Learning Methods How competence is assessed
6.1
Be able to discuss the meaning of the Theoretical education programme Testimonial following assessment during period of supervised practice
term ‘displacement value’ and +
demonstrate safe, effective and consistent Completion of individual professional CPD record
numerical ability when calculating
displacement values (Cross Ref Topic 3-
Calculations)
23
Section A
General Underpinning Knowledge
Topic 7
Topic 7 : Aseptic Technique for the Preparation of Injections General Underpinning Knowledge/Directed Reading
Nursing Standard
Lavery I., Paula I. (2006) Prevention of infection in peripheral intravenous www.nursing-standard.co.uk
devices. Nursing Standard, (49): 49-56.
http://www.scotland.gov.uk/Publications/2002/12/16049/15908
The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Chapters 4, 9 &
th
11. 6 Edition. Blackwell Publishing. Oxford 2004
24
Section A
Competency Framework
Topic 7: Aseptic Technique for the Preparation of Injections
7.1
Be able to discuss the procedure to Local course for the preparation of Testimonial following assessment during period of supervised practice +
prepare injections aseptically and be able injections + Completion of individual professional CPD record
to demonstrate the effective adherence to Period of supervised practice
aseptic principles when preparing
injections
25
Section A
General Underpinning Knowledge
Topic 8
Topic 8 : Standard Preparation Methods for the Preparation of Injections General Underpinning Knowledge/Directed Reading
26
Section A
Competency Framework
Topic 8: Standard Preparation Methods for the Preparation of Injections
8.1
Be able to demonstrate the agreed Directed reading + Simulation during theoretical educational session +Testimonial following assessment
standard procedure for the preparation Local course for the preparation of during period of supervised practice + Completion of individual professional CPD record
of an injection injections + Period of supervised
practice
8.2
Be able to define the term ‘Ready to Directed reading + Testimonial following assessment during period of supervised practice
Use’ injection and discuss the rationale Local course for the preparation of +
for the prescribing of injections in a injections Completion of individual professional CPD record
‘Ready to Use’ form in preference to
prescribing injections that require to be
manipulated prior to administration
8.3
Be able to identify reference sources Directed reading + Testimonial following assessment during period of supervised practice +
that provide supportive guidance on Local course for the preparation of Completion of individual professional CPD record
standard doses and concentrations of injections
injectable medications
(Cross Ref with topic 13)
8.4
Be able to discuss the local procedure Directed reading + Testimonial following assessment during period of supervised practice +
for the safe disposal of clinical waste Local course for the preparation of Completion of individual professional CPD record
following the preparation of an injection injections
and demonstrate the consistent
adherence to local policies and
procedures
(Cross Ref with topic 12)
27
Section A
General Underpinning Knowledge
Topic 9
Topic 9 : Checking Procedures Prior to and During Administration of General Underpinning Knowledge/Directed Reading
Injections
Management of anaphylaxis
Management of cardiopulmonary resuscitation
Management of extravasation
Reporting of adverse event/medication incidents
28
Section A
Competency Framework
Topic 9: Checking Procedures Prior to and During Administration of Injections
9.1
Be able to describe the procedures for Directed reading + Local course for Testimonial following assessment during period of supervised practice +
the assessment of the patient prior to and the preparation of injections Completion of individual professional CPD record
during the administration of an injection to
minimise the risks to patients
9.2
Be able to describe the effective Directed reading + Testimonial following assessment during period of supervised practice
identification and management of an Local course for the preparation of
adverse event/medication incident that injections
occurs during the administration process
29
Section A
General Underpinning Knowledge
Topic 10
Topic 10 : Documentation for the Preparation and Administration of General Underpinning Knowledge/Directed Reading
Injections
Competency 10.1 Local procedures and policies for the recording of the:
Prescribing of injections
Administration of injections
Section A
Competency Framework
30
Topic 10: Documentation for the preparation and administration of medicines
10.1
Demonstrate Local course for the preparation of Testimonial following assessment during period of supervised practice
injections
i) effective record keeping in
relation to the administration of
injectable medications and the
consistent accurate completion of
documentation
31
Section A
General Underpinning Knowledge
Topic 11
Hospital Pharmacist
Millar A., Hughes D., Kerr S., et al.(2006) The safe preparation of injections in http://www.pjonline.com/pdf/hp/200604/hp_200604_injections.pdf
near -patient areas, Hospital Pharmacist,13 128-131.
Section A
Competency Framework
Topic 11: Labelling Requirements for Injections
11.1
Be able to prepare and label an Directed reading Testimonial following assessment during period of supervised practice
injection according to local and +
national guidance Local course for the preparation of injections
32
Section A
General Underpinning Knowledge
Topic 12
Topic 12 : Disposal of Waste, Including Medicines, Containers and General Underpinning Knowledge/Directed Reading
Sharps
Hospital Pharmacist
Millar A., Hughes D., Kerr S., et al.(2006) The safe preparation of injections in http://www.pjonline.com/pdf/hp/200604/hp_200604_injections.pdf
near -patient areas, Hospital Pharmacist,13 128-131.
Disposal of needles
Disposal of syringes
Disposal of ampoules and vials
33
Section A
Competency Framework
Topic 12: Disposal of Waste, Including Medicines, Containers and Sharps
12.1
Be able to describe the procedures for the Directed reading + Testimonial following assessment during period of supervised practice +
safe disposal of clinical and non - clinical Local course for the preparation of Completion of individual professional CPD record
waste following the injections
preparation/administration of an injection
34
Section A
General Underpinning Knowledge
Topic 13
Competency 13.1 Local procedures and policies for the Safe and Secure Handling of Medicines
Section A
Competency Framework
Topic 13: Product Monographs
13.1
Be able to describe the reference Directed reading Testimonial following assessment during period of supervised practice +
sources required when preparing an + Completion of individual professional CPD record
injection Local course for the preparation of
injections
(Cross Ref with topic 8.3)
35
Section A
General Underpinning Knowledge
Topic 14
Topic 14 : Awareness of Control of Substances Hazardous to Health, General Underpinning Knowledge/Directed Reading
and Other Health and Safety Considerations
36
Section A
Competency Framework
Topic 14: Awareness of Control of Substances Hazardous to Health, and Other Health and Safety Considerations
14.1
i) Be able to describe a range of health Directed reading + Testimonial following assessment during period of supervised practice +
and safety issues (hazards) that may Local course for the preparation of Completion of individual professional CPD record
arise during the preparation of an injections
injections
14.2
Be able to identify any actions required Directed reading + Testimonial following assessment during period of supervised practice
to minimise risk to the practitioner and the Local course for the preparation of
environment when the injection is being injections
prepared
37
14.3
Be able to discuss the procedure for Local course for the preparation of Testimonial following assessment during period of supervised practice
completion of a risk assessment in order to injections
determine the most appropriate location for
the preparation of an injection
14.4
Be able to identify the reasons for the Directed reading + Testimonial following assessment during period of supervised practice +
preparation of ‘high risk medicines’ by Local course for the preparation of Completion of individual professional CPD record
specially trained pharmacy staff (e.g. injections
pharmacy staff in an aseptic dispensing
facility) and be able to identify at least 2
injections that would be unable to be
prepared within the near- patient area
(i.e. high risk injections)
14.5
Be able to describe the rationale for the Directed reading + Assessment during period of supervised practice
immediate administration of injections Local course for the preparation of
that have been prepared in the near – injections
patient area
38
Section B
Examples of practice occurring throughout Scotland as part of the ‘scoping exercise’ undertaken for
development of this guidance document
o Guidance relating to minimum grade of staff who should achieve competence in the preparation of
injections in near-patient areas
o Refresher courses
o A standard framework for the period of agreed supervised practice
o A competency framework for completion prior to, during and after the educational session
o A supervised practice standards (e.g. the practitioner needs to prepare each form of injection an
agreed number of times (e.g .five times), prior to being signed off as competent in the workplace (e.g.
minimum of 10 injections within a 4 week period)
o A standard framework available for recognition of practitioners accredited as competent to prepare
injections in near-patient areas
o Central recording of all practitioners registered to practice, with the individuals date of
re - accreditation detailed
39
Section B
Organisations where:
Topic 3 Calculations and checking o Practitioners ‘practise’ calculations prior to attending the educational session
procedures prior to o The calculations required to be completed for accreditation are available on CD ROM/on line for and
preparation may be completed prior to the session
o There are procedures in place to ensure that practitioners receive feedback on performance in
completion of calculations prior to attendance at an educational session
o There is an agreed pass mark of 100% and where there are procedures to support practitioners who
do not achieve the pass mark
o Further calculations are undertaken as part of a ‘refresher’ training/process after initial accreditation
Topic 4 Drug Incompatibilities Organisations where the educational sessions:
o Inform of the pharmacology of an agreed list of ‘core’ medicines
o Inform of the pharmacokinetics of drugs with a narrow therapeutic range
o inform of antibiotics and sensitivities to certain medicines
o Specialists are involved in delivery of relevant parts of the session
(i.e. pharmacy staff, infection control specialists etc.)
Topic 7 Aseptic Technique Organisations where:
o Practitioners are given the opportunity to undertake simulated preparation of an injection prior to a
period of agreed supervised practice
40
Topic 14 Organisations where the educational session informs of:
Awareness of Control of
Substances Hazardous to o The differences in the nature of medicines and the reasons why hazardous/high risk complex
Health and other Health medicines must be made up by appropriately trained pharmacy personnel (e.g. parenteral nutrition,
and Safety Considerations chemotherapy)
o The principles of COSHH and details some of the hazards involved in the preparation of medicines
and how to minimise any risks that may occur during the preparation and administration of the
medicine. Such hazards may be to the practitioner or to the patient (if standard procedures
are not followed)
o The role of the practitioner, the procedure for the completion of a risk assessment in order
To determine the level of risk associated with the medicine
Organisations where there is standard documentation for undertaking a risk assessment, that is widely
available to practitioners and which guides the practitioner to the most appropriate location for preparation of
the medicine (There are procedures for referral to pharmacy for the preparation of high risk / complex
medicines (e.g. chemotherapy, parenteral nutrition (PN)).
41
Section C
42
Competency 2.4 Information that details the following hazards:
Competency 2.6 Information that informs of hazards that may affect the medicine that is being
administered:
Competency 2.6 Information that informs of hazards that may affect the patient during
administration of the medicine e.g. the signs and symptoms of:
Competency 2.7 Information that informs of some potential hazards that may be encountered
within a patient’s home or a GP’s surgery
43
Competency 3.1 Information that describes how to calculate:
Competency 3.3 Information that describes a standard method of preparation and informs of
the in process checks required to ensure :
○fluids to which drugs should not be added when they are being
administered (e.g. parenteral feeding fluids, enteral feeding fluids or blood
products)
Competency 4.2 Information that informs of factors that influence the volume of fluid that may be added
to a medicine:
○route of administration ○displacement volumes ○required final concentration
of the product ○the dose of the drug required
44
Competency 5.1 Information that informs of factors that influence the stability of an injection:
Competency 8.1 Information that details the standard preparation for injections
Competency 8.4 Information that informs of the procedures and policies relating to the
disposal of waste in particular the different :
Competency 9.1 Inform of procedures for assessment of the patient prior to and during
administration of the medicine:
45
infusion container/syringe ○name and volume of diluent/infusion fluid ○the
rate and duration of administration ○the date on which treatment should be
reviewed ○the the type of device to be used for administration of the
medicine
Competency 14.1 Information that informs how to ensure the health and safety of self and
others:
○ minimisation of risks/hazards to the environment
○ minimisation of risks/hazards to the operator
46
Competency 14.3 Information that informs of processes, procedures and documentation
associated with a risk assessment :
N.B. Where preparation will occur with the clinical environment ( i.e. in the patient’s home), then
a risk assessment needs to be undertaken prior to the patient being discharged from hospital.
Competency 14.5 Information that conveys the rationale for the immediate administration of medicines
when prepared in the clinical environment:
47
Acknowledgements
The group wish to acknowledge the help of all involved in the consultation exercise and in particular the support provided from; the Chief Nurses, NHS Quality
Improvement Scotland, the pharmacy aseptic specialist interest group (ASSIG) and the various practitioners who submitted training programmes and
supporting documentation as part of the project.
Particular thanks to Linda Russell, Senior Pharmacy Technician, Queen Margaret Hospital, Fife, for development of the questionnaire and collation of the
various documents up until June 2005.
48
Appendix I
References
1. Scottish Executive Health Department (2002) Good Practice Statement for the Preparation of Injections in Near-Patient Areas, Including Clinical and
Home Environments, Edinburgh: SEHD.
2. Scottish Executive Health Department (2002) HDL 91 Good Practice Statement for the Preparation of Injections in Near-Patient Areas, Including Clinical
and Home Environments, Edinburgh: SEHD.
3. NHS Education for Scotland (2004) Transferring the Skills: Quality assurance framework for venepuncture, cannulation and intravenous therapy (draft),
Edinburgh, NES.
4. Millar, A. Hughes, D. Kerr, S. et al. (2006) The safe preparation of injections in near-patient areas. Hospital Pharmacist,13, 128-131.
5. The National Patient Safety Agency website. Patient Safety Alert 20.(2007) Promoting safer use of injectable medicines.
49
Appendix II
Glossary of Terms 1,5
5
Administration devices Medical devices designed to regulate or control, mechanically
or electronically, the administration of injections or infusions of
medicines
1
Aseptic dispensing The preparation of a medicine that is appropriate for issue or
administration to a patient, by a method of handling sterile
material that employs techniques which minimise the risk of
microbial contamination
5
Aseptic technique Handling technique designed to minimise the risk of microbial
contamination of a sterile medicine during preparation
5
Bolus (push)
Administration from a syringe of a small volume of a single
dose of a sterile solution directly into a tissue, organ or vein,
over a short time of, usually, between 30 seconds and
10minutes
5
Clinical areas
Wards, clinical departments, operating theatres, clinics, GP
surgeries. In the context of home care, the term may also be
considered to include the patient’s home
5
Diluent Any sterile injection solution, such as water for injection or
sodium chloride 0.9%, commonly used to dissolve
(reconstitute) or dilute a medicine immediately before
administration
50
5
Hazard Any factor, such as a difficult procedure or a complex
calculation, with the potential to cause harm if carried out
incorrectly
1
High Risk Where the hazard associated with preparation is likely to have
serious consequences for the patient or operator
5
Infusion Administration, from a syringe or other rigid or collapsible
container e.g. plastic bag, of a volume of sterile solution of an
injectable medicine directly into a tissue, organ or vein or
artery, at a constant rate, under gravity or by means of an
electronic or mechanical pump or other means of rate control,
over a defined period usually of at least 10 minutes
5
Injectable medicines Sterile medicines intended for administration by bolus injection,
perfusion or infusion by any of the following routes:
intravenous, intramuscular, intrathecal, intra - articular,
subcutaneous, intradermal, intraventricular, epidural,
intravesicular, intravitreal, intrapelural and intraocular
1
Licensed manufacturer Possessing a licence from the Licensing Authority (the
Medicines Control Agency) to operate as a manufacturer of
pharmaceutical products
1
Low risk Where the hazard associated with preparation is unlikely to
have serious consequences for the patient or operator
1
Multi – professional Doctors, nurses, pharmacists and other healthcare
professionals involved with prescribing, preparing or
administering injectable medicines
51
1
Near – patient area (s) The general area in which the patient is examined, treated and
cared for e.g. the ward, the clinic or surgery, the patient’s
home
1
Parenteral Administered by injection, infusion or implantation into the
body
1
Preparation The manipulation of ingredients and components to make a
final product
5
Ready – to- administer injectable products These products require no further dilution or reconstitution and
are presented in the final container or device, ready for
administration or connection to a needle or administration set.
For example, an infusion in a bag with no additive required
5
Ready – to use injectable products These products require no further dilution or reconstitution
before transfer to an administration device. For example, a
liquid with an ampoule, of the required concentration, that only
needs to be drawn up into a syringe
52
Appendix III
Membership of Steering and Reference Groups
53
Marina Shannon Dr David McQueen
Practice Development Specialist, Critical Care and Theatres, Post Graduate and Foundation Tutor, NHS Forth Valley
NHS Lanarkshire
Charles Sinclair
Head of PPDNU
Operational Division, NHS Fife
54
Appendix IV
Respondents to the Consultation
Name Organisation
55
E Noble NHS Borders
56
NHS Education for Scotland
rd
3 Floor
2 Central Quay
89 Hydepark Street
Glasgow
G3 8BW
August 2007.
57